Milk and gout. Water first, but then drink milk. Or orange juice





This page on milk and gout was last reviewed, or updated, on 18 April 2013.

John Locke, the 17th century philosopher, Sir Alfred Garrod, the first person to realise (realize) that gout is usually caused by an excess of uric acid, and Dr. Alexander Haig, the British writer of bestselling books about uric acid at the end of the nineteenth century, have all said it - milk is good for gout. So did the Canadian born physician who has been described as the father of North American medicine, Sir William Osler, for many years a professor at Johns Hopkins University School of Medicine in Baltimore, Maryland. 

They were all exceptional people who knew gout well.

MILK IS LOW PURINE 

1950's low purine diets stressed it too, and it just so happens that although Messrs Locke and Garrod could not have known it, milk, and dairy products made from it such as cheese, yoghurt (yogurt) and cream are low purine. 

According to one purines table, these dairy products, and eggs, contain between 0 - 50 mg of purines per 100 grams of food, which makes them low purine. And yes, ice cream too, but watch the sugar in it if you are on a restricted carbohydrate diet for gout, or make your own at home using a sweetener like sucralose (Splenda). Or buy no-sugar ice cream if you live in a country where this is made. 

Because of its lowering uric acid properties the lowering uric acid property of milk makes it an excellent drink for the elderly, since slowly over time uric acid has a tendency to rise. 

I should say I'm talking about cow's milk here, not any other kind, since cow’s milk’s proteins have been studied. But any milk which contains the proteins I am going to explain, will probably have a similar effect. 

MILK AND GOUT – A BETTER REASON FOR DRINKING MILK

Low purine foods are fine for a low purine diet, but there are better reasons why, if you drink milk gout might be alleviated, and your uric acid level lowered a little. It has been reliably found that milk can lower serum (blood) uric acid (UA) levels.

Some people will be surprised to read that it's done by milk proteins, because they think protein raises uric acid. And milk can also improve uric acid excretion. So there's a double whammy gout improvement. 

The two proteins in milk that do this are casein, the main protein in milk, and lactalbumin. But as with all natural remedies for gout, and diets that lower uric acid, don't expect a huge reduction. 

MILK LOWERS URIC ACID 

A Canadian study in 1991, published in The American Journal of Clinical Nutrition, (3) found that casein and lactalbumin lowered serum (blood) uric acid in healthy volunteers by slightly over 0.5 mg/dL, which is not a lot, but useful. The reduction happened in three hours, but this wasn’t a long study over a few months. And the participants increased uric acid excretion. The researchers used 80 grams of milk proteins in water, not milk itself.

However, the amount of milk protein required to lower uric acid by this amount was high. You'd need to drink about 10 x 8 fluid ounces glasses of milk a day to equal the amount of casein and lactalbumin the healthy volunteers took in water, because there's about eight grams of protein in an eight ounce glass of milk. 

That's a lot of milk for a 0.5 mg/dL reduction, and the reduction was not quite as good as just a couple of glasses of orange juice, in an orange-juice-effect-on-uric acid-levels-study.

However, it was a short study. If it had been run longer perhaps the UA reduction would have been higher – 1.0 mg/dL doesn’t seem unreasonable over a couple of months, but that’s still a guess. But drinking milk is certainly better than drinking alcohol, which will almost certainly raise your uric acid, unless it's a very moderate amount of wine. So milk and gout prevention go together.

OR DO YOU DRINK A GLASS OF MILK A DAY? 

On the other hand, and this is more realistic, although one glass of milk a day doesn't seem much, if you do it regularly over the years, it means something. In a study of nearly 15,000 Americans who drank at least one glass a day consistently for about six years, they had a 0.25 mg/dL lower serum (blood) UA level than those who didn't (1). This difference was calculated as being accounted for by the milk, not anything else.

Cheese and gout And in this study, those who ate all kinds of cheese, (which performed slightly better than milk) and yoghurt (yogurt), (about the same) also had lower uric acid levels. These were not low fat products. Meal tip  - eat cheese with celery four or five stalks at a time. Cheddar is traditional. It's a very anti-gout snack. 

Live cultured yoghurt (yogurt) could not only lower UA by these proteins, but be good for gut bacteria, where a third of uric acid is dissolved.

Milk and gout risk 

If, every day, you drink just one glass of milk, gout could be less likely to eventually attack you. Why? Because another somewhat similar large population study to the one mentioned above found that the risk of getting gout in men was less by something over 50% if they drank at least a glass of low fat milk a day.(2) Low fat yoghurt (yogurt) of at least two 1 cup servings a week was also associated with a lower risk of gout, in this case better than low fat milk. And in this study whole milk of at least two glasses a week had no discernible risk of gout. Unfortunately there were no published figures for a glass or more of whole milk daily.

Another milk and gout-positive study 

And in 2010, a study in New Zealand, published in the Annals of the Rheumatic Diseases  journal found that skim milk lowered uric acid by about 10% in three hours, and also quickly increased uric acid excretion. It was a similar result to the 1991 Canadian study (above), but this time the researchers mainly used various types of skim milk, not milk proteins in water.(4) But participants had to drink less milk than the milk proteins and water of the Canadian study, to achieve somewhat similar results. And it probably wasn't just the proteins that lowered uric acid. The milk tested contained orotic acid, which also has a reputation for lowering uric acid.

BUT WATER USE IN GOUT COMES FIRST 

So milk is good for gout, but is it as good as water? Those eight glasses of eight fluid ounces of water, or two litres (liters), or 3.2 U.K. pints (rounded numbers) are your first priority because milk has not been shown to achieve what water can. With this much water - the precise therapeutic amount is individual-specific, and you have to learn how much by trial and error - it’s possible to stave off gout attacks, or relieve them, or even avoid them completely. Even in some cases without adding a small amount of bicarbonate of soda (baking soda). 

URIC ACID IS NOT VERY SOLUBLE 

You have to drink a lot of water because uric acid is not very soluble - it needs a lot of water to help excrete it and halt crystallisation (crystallization). Or you get a more alkaline effect if you drink ionized water, or add pH drops, to your water. But no one has studied (or has said publicly) what drinking this amount of milk at the beginning of a gout attack can do and there are no testimonials.

Although cow’s milk is 88% water, milk does not dilute uric acid as far as I know. Unlike plain water, which is pH neutral but alkaline if you alkalise (alkalize) it in some way, milk is an acidic substance which means it won’t alkalise (alkalize) and help dilute uric acid and halt crystallisation.  But water does dilute it, even if you need a lot of it. And, as mentioned, you can always increase water's pH potential if you add baking soda (bicarbonate of soda), as long as your doctor agrees, your blood pressure isn't high, and you have no heart or kidney problems. 

Read the pH pages for a longer explanation. They begin here.

So to drink 10 x 8 fluid ounces of milk, after all that water every day, is a tall order. A glass or two, after all that water, is more realistic, and as the study discussed above showed, if you make it a regular habit, over time it should lower your uric acid, all by itself, somewhat. And eating associated dairy products like cheese (any cheese) and yoghurt (yogurt) is a good idea. This means cheese, even if it comes in plastic, not cheese based products.

A caveat Studies (3) and (4) were not tested with gout sufferers, but (1) and (2) involved gout.

Lactose intolerance If you are lactose (the main sugar in milk) intolerant – meaning you can’t metabolise (digest) it – use lactose free milk. If it isn’t in your regular supermarkets, you should be able to buy it in health food stores.

If anybody does have success with a daily ten glasses of milk before or during a gout attack, please let us know using the Contact Us page.

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Read about a very encouraging study, not mentioned on this page, that demonstrated gout flare and pain reduction from a specially formulated milk drink.

WHEY comes from milk. Click here to find out if it's a good food for gout.

Milk and Gout References

(1) Intake of Purine-Rich Foods, Protein, and Dairy Products and Relationship to Serum Levels of Uric Acid. The Third National Health and Nutrition Examination Survey. Hyon K.Choi, Simin Liu, and Gary Curhan.Arthritis & Rheumatism, Vol. 52, No. 1, January 2005, pp 283–289.

(2) Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men. Hyon K. Choi, M.D., Karen Atkinson, M.D, Elizabeth W. Karlson, M.D., Walter Willett M.D.and Gary Curhan, M.D, New England Journal of Medicine 350;1093-1103.March 11, 2004.

(3) Milk and soy-protein ingestion: acute effect on serum uric acid concentration. Dominique R. Garrel, Maurice Verdy, Claude PetitClerc, Christophe Martin, Danielle Brule, Pavel Hamet. American Journal of Clinical Nutrition 1991;53:665-9.<br>

(4) Abstract.Acute effect of milk on serum urate concentrations: a randomised controlled crossover trial. Dalbeth N, Wong S, Gamble GD, Horne A, Mason B, Pool B, Fairbanks L, McQueen FM, Cornish J, Reid IR, Palmano K. Annals of the Rheumatic Diseases. 2010 May 14. 



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